Provider Demographics
NPI:1083833966
Name:ACTIVECARE PHYSICAL THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ACTIVECARE PHYSICAL THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:508-385-1900
Mailing Address - Street 1:305 HOKUM ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2357
Mailing Address - Country:US
Mailing Address - Phone:508-385-1900
Mailing Address - Fax:508-546-3050
Practice Address - Street 1:305 HOKUM ROCK RD
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2357
Practice Address - Country:US
Practice Address - Phone:508-385-1900
Practice Address - Fax:508-546-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT0305Medicare PIN